Can Optical Surface Imaging Replace Non-coplanar Cone-beam Computed Tomography for Non-coplanar Set-up Verification in Single-isocentre Non-coplanar Stereotactic Radiosurgery and Hypofractionated Stereotactic Radiotherapy for Single and Multiple Brain Metastases?

AIMS

To conduct a direct comparison regarding the non-coplanar positioning accuracy between the optical surface imaging system Catalyst HDTM and non-coplanar cone-beam computed tomography (NC-CBCT) in intracranial single-isocentre non-coplanar stereotactic radiosurgery (SRS) and hypofractionated stereotactic radiotherapy (HSRT).

MATERIALS AND METHODS

Twenty patients with between one and five brain metastases who underwent single-isocentre non-coplanar volumetric modulated arc therapy (NC-VMAT) SRS or HSRT were enrolled in this study. For each non-zero couch angle, both Catalyst HDTM and NC-CBCT were used for set-up verification prior to beam delivery. The set-up error reported by Catalyst HDTM was compared with the set-up error derived from NC-CBCT, which was defined as the gold standard. Additionally, the dose delivery accuracy of each non-coplanar field after using Catalyst HDTM and NC-CBCT for set-up correction was measured with SRS MapCHECKTM.

RESULTS

The median set-up error differences (absolute values) between the two positioning methods were 0.30 mm, 0.40 mm, 0.50 mm, 0.15°, 0.10° and 0.10° in the vertical, longitudinal, lateral, yaw, pitch and roll directions, respectively. The largest absolute set-up error differences regarding translation and rotation were 1.5 mm and 1.1°, which occurred in the longitudinal and yaw directions, respectively. Only 35.71% of the pairs of measurements were within the tolerance of 0.5 mm and 0.5° simultaneously. In addition, the non-coplanar field with NC-CBCT correction yielded a higher gamma passing rate than that with Catalyst HDTM correction (P < 0.05), especially for evaluation criteria of 1%/1 mm with a median increase of 12.8%.

CONCLUSIONS

Catalyst HDTM may not replace NC-CBCT for non-coplanar set-up corrections in single-isocentre NC-VMAT SRS and HSRT for single and multiple brain metastases. The potential role of Catalyst HDTM in intracranial SRS/HSRT needs to be further studied in the future.

[CD7 expression and its prognostic significance in acute myeloid leukemia patients with wild-type or mutant CEBPA]

目的

分析CD7在初治急性髓系白血病（AML）患者中的表达和预后价值，进一步探讨CD7表达情况与CEBPA突变的相关性，明确其在CEBPA野生型和突变型AML患者中与预后的关系。

方法

回顾性分析2010年1月至2016年12月收治的298例初治AML患者（除外M₃亚型）的临床资料，在全部患者以及CEBPA野生型和突变型组中，分别比较CD7阳性（CD7⁺）和CD7阴性（CD7⁻）患者的临床特征及预后差异，并联合CD7表达情况和CEBPA突变状态初步建立新的危险分层模型。

结果

在CD7⁺组中，CEBPA单位点和双位点突变的发生率分别为10.1%和33.9%，显著高于CD7⁻组（5.3%和4.2%），差异具有统计学意义（P=0.000）。在CEBPA野生型患者中，CD7⁺组患者相较CD7⁻组患者完全缓解率低（P=0.001）、复发率高（P=0.023），而两组总生存（OS）期和无病生存（DFS）期差异无统计学意义（P值均>0.05）；在CEBPA突变患者中，CD7⁺组显示有更长的OS期（P=0.019）和DFS期（P=0.010）。根据CD7表达和CEBPA突变与否将AML患者分为三个亚组：CD7⁺伴CEBPA突变组、CD7⁻组和CD7⁺伴CEBPA野生型组。三组患者的3年OS率分别为80.2%、48.0%和30.6%（P<0.001），3年的DFS率分别为74.1%、37.4%和22.2%（P<0.001）。

结论

CD7⁺组中CEBPA突变率显著高于CD7⁻组，CD7⁺在CEBPA野生型组和突变组AML中存在截然相反的预后意义。根据CD7表达情况和CEBPA突变与否建立新的危险分层模型，有助于指导临床个体化治疗。

[The effect of combined therapy on seasonal allergic rhinitis]

Objective:To observe the effect of combined therapy on seasonal allergic rhinitis(AR) and quality of life.Method:Ninety-six patients with severe seasonal AR unresponsive to intranasal corticosteroids alone were divided randomly into nasal budesonide group(group A),Nasal Budesonide combined with fexofenadine hydrochloride group(group B),and budesonide combined with montelukast group(group C).The symptom scores,Uni-VAS,and rhinoconjunctivitis quality of life(RQLQ) were evaluated 2 and 4 weeks after treatment initiation.Result:In the group B and C,the symptom scores,Uni-VAS,and RQLQ were significantly lower than the group A(P<0.05).As for nasal itching(after 2 weeks),rhinorrhea and sneezing,the symptom scores and Uni-VAS of group B were significantly lower than that of group C(P<0.05).However,compared to group B,the improvement of nasal obstruction in group C was much better(P<0.05).There was no significant difference in other symptoms and RQLQ.Conclusion:For patientswith severe seasonal AR unresponsive to intranasal corticosteroids alone,combined therapy can help alleviate clinical symptoms and improve quality of life.The combination of drugs should be individulized based on the severity of symptoms.

[Clinical application of retroperitoneal laparoscopic surgery combined with mini-flank incision "hybrid surgery" for partial nephrectomy of complex renal tumors]

OBJECTIVE

To evaluate the clinical effect and safety of retroperitoneal laparoscopic surgery combined with mini-flank incision "hybrid surgery" for partial nephrectomy of complex renal tumors.

METHODS

Between April 2015 and December 2016, the clinical data from 16 patients with complex renal tumors who underwent the "hybrid surgery", including 10 males and 6 females, were retrospectively reviewed. The average age was (50.2±10.7) years, 9 cases were located in the left side and 7 cases in the right side, the mean tumor size was (6.1±1.0) cm, and the mean R.E.N.A.L. nephrometry score was 9.3±1.3. All the patients received the "hybrid surgery", the first step was to adequately mobilize the kidney and tumor, prepared the renal artery by retroperitoneal laparoscopy, and then the incision about 10-12 cm was done under the twelve rib to convert to open surgery. After the renal artery was clamped, the tumor was removed and the wound was closed under direct vision. The operative time, ischemia time, estimated blood loss, intraoperative and postoperative complications and short-term renal function were recorded.

RESULTS

All the 16 patients' "hybrid surgeries" were successfully performed. The mean operative time was (164.9±23.6) min, mean ischemia time was (32.4±6.2) min, and mean estimated blood loss was (204.0±125.1) mL. The mean drainage tube removal time was (4.1±1.0) d, and the mean postoperatively hospital stay was (6.9±1.5) d. There were 2 patients with Clavien III grade complications. One patient was injured with collecting system, and 1 patient received a second emergency surgery for acute postoperative bleeding. The mean 1 day postoperative serum creatinine level was (126.3±26.4) μmol/L, which was statistically significant (P<0.05) compared with the preoperative serum creatinine level(74.3±16.9)μmol/L. There were no significant differences (P>0.05) in comparing the 1 month postoperative serum creatinine level (92.6±18.2) μmol/L, 3 months postoperative serum creatinine level (80.8±18.4) μmol/L with the preoperative serum creatinine level. During 3 to 20 months follow-up periods, no local recurrence or distant metastasis occurred.

CONCLUSION

This "hybrid surgery" combined retroperitoneal laparoscopic surgery with mini-flank incision for partial nephrectomy is safe and effective. It could decrease the operative difficulty and be worthy of further application for some selected complex renal tumor patients.

[Comparison of three surgical methods of ureteropelvic junction obstruction in therapeutic effect and complication]

OBJECTIVE

To compare various data of open pyeloplasty, laparoscopic pyeloplasty and endopyelotomy as a treatment of ureteropelvic junction obstruction (UPJO), and to investigate and discuss the feasibility and effect of the three methods.

METHODS

In the study, 109 cases of UPJO treated by different surgical approaches in Peking University People's Hospital from January 2004 to December 2014 were retrospectively investigated. The patients were divided into three groups according to the treatment they received: open peyloplasty group (32 cases), laparoscopic peyloplasty group (31 cases) and endopyelotomy group (46 cases).We compared the data of the operative time, intraoperative blood loss, perioperative complications and post-operative hospital stay among the three groups. The mean follow-up time was(51.9±40.1) months (6-132 months).

RESULTS

None of the laparoscopic peyloplties was converted to open peyloplasty. All endpyelotomies were successfully completed. The operative time was as follows: laparoscopic peyloplasty group (195.97±55.22) min, open peyloplasty group (121.19±33.95) min and endopyelotomy group (74.04±33.95) min,and there were significant differences among the three groups respectively(P<0.001). There was no significant difference on the operative blood loss between open peyloplasty group and laparoscopic peyloplasty group (P=0.163). The operative blood loss of endopyelotomy group was 5(0,310)mL,which was lower than the other two groups, and this result had significant differences with the other two groups respectively(P<0.001). There were significant differences on the post-operative hospital stay (days) among open peyloplasty group, laparoscopic peyloplasty group and endopeylotomy group (P<0.05,respectively).The success rate was comparable between open peyloplasty group and laparoscopic peyloplasty group( 93.8% vs. 90.3%, P=0.672), while the endopeylotomy group had a lower success rate compared with both open surgery group and laparoscopic group(69.6% vs. 93.8%, P=0.01; 69.6% vs. 90.3%, P=0.048, respectively). The complication rates of open peyloplasty group, laparoscopic peyloplasty group and endopeylotomy group were comparable(15.6%, 16.1% and 13.0%, respectively, P>0.05).

CONCLUSION

The laparoscopic peyloplasty group had a longer operative time than open peyloplasty group, while its post-operative stay was shorter. There was no significant difference on the operative blood loss between open peyloplasty group and laparoscopic peyloplasty group. Although the success rate of endopyelotomy was lower than those of the other two groups, it had advantages over the aspect of operative time, operative blood loss and post operative stay.

[Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria via extra-adipose capsule]

OBJECTIVE

To evaluate the clinical effect of retroperitoneoscopic renal pedicle lymphatic disconnection via extra-adipose capsule in the management of chyluria and to discuss the management of its complications.

METHODS

From August 2013 to June 2008, five patients with chyluria were admitted. All the patients were female, aged from 26 to 73 years, and disease course from 1 to 10 years. All the five patients had complained of intermittently voiding milky urine with varying degrees of weight loss, and fatigue, of whom two presented with flank pain and one with anemia. Their urine chyle tests were confirmed to be positive. Preoperative cystoscopy found that chyluria was from the left side in 3 cases,and from the right side in 2 cases. Their proteinuria ranged from + to ++++. All the cases had been treated with the modified procedure by which lymphatic ligation was performed to hilar vessels and proximalureter via extra-adipose capsule without disconnection of perirenal fat tissues. The operation time, intraoperative blood loss, postoperative intestinal function recovery, catheter time, drainage tube removal time and complications during operation were collected.

RESULTS

All the five cases were performed successfully. The operation time ranged from 75 to 170 minutes, mean (126.0±39.6) minutes, with the intraoperative blood loss 20 to 60 mL, mean (38.0±16.4) mL, and the postoperative intestinal function recovery time 1 to 3 days, mean (1.9±0.4) days. The catheter time was 1 to 4 days, mean (2.1±0.3) days and the drainage tube removal time ranged from 3 to 15 days, mean (9.3±1.8) days. Postoperatively lymphorrhagia was found in two cases. No renal vessels injury occurred during operation. Chyluria of all the patients disappeared on the operation day with negative chyluria test after surgery. Furthermore, urine test revealed that proteinuria was totally negative. No recurrence was detected in our patients in the 9 to 31 months' follow-up.

CONCLUSION

This modified procedure does not have to disconnect perirenal fat tissues and nephropexy during operation. It was characterized with shorter operation time, definitive effect and fewer complications.

[Diffusion-weighted imaging characteristics of uterine leiomyomas with different pathological subtypes at 3.0 T]

OBJECTIVE

To investigate the imaging features of uterine leiomyomas with different pathological subtypes on DWI.

METHODS

Clinical records and MR images of pathologically confirmed uterine leiomyomas were retrospectively collected from the Second Affiliated Hospital of Wenzhou Medical University from June 2012 to April 2015. A total of 60 uterine leiomyomas were found and evaluated.All the patients were divided into three groups according to different pathological types, which included 17 cases of cellular leiomyomas, 10 cases of degenerated leiomyomas and 33 cases of ordinary leiomyomas.The DWI signal and ADC values in cellular portion of the lesions and adjacent normal myometrium (the control group) were measured.

RESULTS

(1) Most cellular leiomyomas showed hyperintensity on DWI (15/17), while degenerated leiomyomas manifested hypointensity, isointensity or hyperintensity signal on DWI, and most ordinary leiomyomas displayed isointensity signal on DWI (57.6%, 19/33). (2) The ADC values of cellular leiomyomas, degenerated leiomyomas and ordinary leiomyomas were (1.01±0.14)×10(-3) mm(2)/s, (1.73±0.49)×10(-3) mm(2)/s and (1.38±0.22)×10(-3) mm(2)/s respectively.The ADC values of adjacent normal myometrium (the control group) were (1.35±0.16)×10(-3) mm(2)/s.There were no significant statistical differences in the ADC values between ordinary leiomyomas and adjacent normal myometrium (P=0.623). There were significant statistical differences in the ADC values among other groups(all P<0.05). (3)The ROC curve showed that the diagnostic threshold for cellular leiomyomas was 1.11×10(-3) mm(2)/s, the sensitivity and specificity were 88.2%and 93.0% respectively.

CONCLUSION

The signal intensity on DWI and the ADC values are different in uterine leiomyomas with different pathological subtypes.Combination of these two parameters in clinical practice may be helpful to reflect the histopathological characteristics of uterine leiomyomas.

[Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria via extra-adipose capsule]

OBJECTIVE

To evaluate the clinical effect of retroperitoneoscopic renal pedicle lymphatic disconnection via extra-adipose capsule in the management of chyluria and to discuss the management of its complications.

METHODS

From August 2013 to June 2008, five patients with chyluria were admitted. All the patients were female, aged from 26 to 73 years, and disease course from 1 to 10 years. All the five patients had complained of intermittently voiding milky urine with varying degrees of weight loss, and fatigue, of whom two presented with flank pain and one with anemia. Their urine chyle tests were confirmed to be positive. Preoperative cystoscopy found that chyluria was from the left side in 3 cases,and from the right side in 2 cases. Their proteinuria ranged from + to ++++. All the cases had been treated with the modified procedure by which lymphatic ligation was performed to hilar vessels and proximalureter via extra-adipose capsule without disconnection of perirenal fat tissues. The operation time, intraoperative blood loss, postoperative intestinal function recovery, catheter time, drainage tube removal time and complications during operation were collected.

RESULTS

All the five cases were performed successfully. The operation time ranged from 75 to 170 minutes, mean (126.0±39.6) minutes, with the intraoperative blood loss 20 to 60 mL, mean (38.0±16.4) mL, and the postoperative intestinal function recovery time 1 to 3 days, mean (1.9±0.4) days. The catheter time was 1 to 4 days, mean (2.1±0.3) days and the drainage tube removal time ranged from 3 to 15 days, mean (9.3±1.8) days. Postoperatively lymphorrhagia was found in two cases. No renal vessels injury occurred during operation. Chyluria of all the patients disappeared on the operation day with negative chyluria test after surgery. Furthermore, urine test revealed that proteinuria was totally negative. No recurrence was detected in our patients in the 9 to 31 months' follow-up.

CONCLUSION

This modified procedure does not have to disconnect perirenal fat tissues and nephropexy during operation. It was characterized with shorter operation time, definitive effect and fewer complications.

Self-healing of thermally molded commodity plastics based on heat-resistant and anti-aging healing systems

Thermally molded commodity plastics become self-healable by the incorporation of heat-resistant and anti-aging healants.

Self-healing epoxy with a fast and stable extrinsic healing system based on BF3–amine complex

An easily processed healing system consisting of BF₃–amine complex and cycloaliphatic epoxy monomer enables fast healing of cured epoxy within seconds.

3'-UTR polymorphism (rs10434) in the VEGF gene is associated with B-CLL in a Chinese population

We investigated the relationship between a VEGF genetic polymorphism and B cell chronic lymphocytic leukemia (B-CLL). A total of 102 patients with B-CLL and 124 healthy subjects were included in this study. All individuals were typed for the rs10434 in the vascular endothelial growth factor (VEGF) gene using the TaqMan technique. We found that the A allele and the AA genotype of rs10434 were more frequent in B-CLL patients than in control subjects (0.54 vs 0.34; 27 vs 13%; respectively). VEGF alleles and genotypes segregated similarly in patients at different disease stages according to Rai classification. These results suggest a possible association between the VEGF polymorphism and high-risk B-CLL.

Ultrafast self-healing of polymer toward strength restoration

Self-healing materials should take effect immediately following crack generation in principle, but the speed of autonomic recovery of mechanical properties through either extrinsic or intrinsic healing strategy reported so far is not that fast. Mostly, a couple of hours are taken for reaching steady state or maximum healing. To accelerate the healing process, the authors of this work make use of antimony pentafluoride as instant hardener of epoxy and successfully encapsulate the highly active antimony pentafluoride-ethanol complex in terms of hollow silica spheres. Accordingly, self-healing agent based on microencapsulated antimony pentafluoride-ethanol complex and epoxy monomer is developed. Epoxy material with the embedded healant capsules can thus be healed within a few seconds, as demonstrated by impact and fatigue tests. It is believed that the outcome presented here might help to move the self-healing technique closer to practical application, especially when the engineering significance of epoxy material is concerned.

Core/shell structured NaYF4:Yb3+/Er3+/Gd+3 nanorods with Au nanoparticles or shells for flexible amorphous silicon solar cells

A simple approach for preparing near-infrared (NIR) to visible upconversion (UC) NaYF4:Yb/Er/Gd nanorods in combination with gold nanostructures has been reported. The grown UC nanomaterials with Au nanostructures have been applied to flexible amorphous silicon solar cells on the steel substrates to investigate their responses to sub-bandgap infrared irradiation. Photocurrent–voltage measurements were performed on the solar cells. It was demonstrated that UC of NIR light led to a 16-fold to 72-fold improvement of the short-circuit current under 980 nm illumination compared to a cell without upconverters. A maximum current of 1.16 mA was obtained for the cell using UC nanorods coated with Au nanoparticles under 980 nm laser illumination. This result corresponds to an external quantum efficiency of 0.14% of the solar cell. Mechanisms of erbium luminescence in the grown UC nanorods were analyzed and discussed.

Self-healing epoxy composite with heat-resistant healant

To provide self-healing epoxy composite with adequate heat resistance for high-performance application, we developed a novel microencapsulated epoxy/mercaptan healing agent. The key measure lies in usage of diglycidyl ether of bisphenol A (EPON 828) as the polymerizable component and 2,4,6-tris(dimethylaminomethyl)phenol (DMP-30) as the catalyst. Because of the higher thermal stability of EPON 828 and lower volatility of DMP-30, the healing agent and the self-healing composite not only survive high-temperature curing and thermal exposure, but also offer satisfactory capability of autonomous properties restoration, as characterized by both fracture mechanics and fatigue tests. Especially when the operation temperature is not higher than 200 °C, the performance of the healing system is nearly independent of thermal history.

Magnetic properties in Co and Mn-doped ZnO powders and thin films

Zn0.86Co0.14O powder and thin films were prepared by standard solid-state reaction processes and radio-frequency (RF) magnetron sputtering. Magnetic measurements indicate that the powder is paramagnetic for temperatures above 3 K, while the thin films annealed in vacuum are ferromagnetic at room temperature. The saturated magnetization was found to be about 0.6 microB/Co, while the coercive force was found to be 200 Oe at room temperature. The very similar results were also obtained in Zn0.96Mn0.04O powder and thin films. Such different results for the powder and thin films indicate that growth conditions and defects play an important role in producing ferromagnetism.

Syphilis in China: the great comeback

China is currently witnessing a major resurgence of syphilis from the elimination of the disease in the 1960s to 5.3 per 100,000 people incidence in 2000-2005. The reasons for the elimination and subsequent resurgence of syphilis in China lie at the heart of much public health debate, highlighting both the relationship between politics and public health, and the role of government in controlling disease. Were the Draconian measures to control syphilis during the early Mao years a price worth paying for the effective control? Is the recent resurgence of syphilis an inevitable consequence of economic development and greater freedom for the individual, which will ultimately lead to better health for the majority of the population? Could tougher control measures such as those of the early Mao years be re-introduced in the current social and economic climate in China? In this review, we briefly chart the history of the syphilis epidemic in China, its elimination in the 1960s, and its gradual resurgence in the past two decades. We explore the reasons for this resurgence, and we conclude with a discussion on the options for control.

The effects of interleukin-18 on rat articular chondrocytes: a study of mRNA expression and protein synthesis of proinflammatory substances

Interleukin (IL)-18 is a potent stimulator of immunity and augments the severity of type II collagen-induced arthritis (CIA) in rats and mice by enhancing T helper 1 (Th1) cell activation, which increases the production of proinflammatory cytokines and arthritogenic antibodies. In this study, we show that recombinant IL-18 (rIL-18) also has a direct effect on normal rat chondrocytes maintained in vitro inducing them to produce proinflammatory factors including IL-6, regulated upon activation normal T cell expressed and secreted (RANTES), prostaglandin E(2) (PGE(2)) and prostaglandin F(2alpha) (PGF(2alpha)) in a dose- and time-dependent manner. The production of matrix metalloproteinase (MMP)-13, nitric oxide (NO), tumour necrosis factor (TNF)-alpha and IL-1beta were also enhanced, although less intensely. Neutralizing polyclonal anti-rIL-18 antibodies effectively blocked the production of IL-6, PGE(2) and RANTES, as well as mRNA expression for the same products in addition to IL-18 and TNF-alpha. In contrast, neutralizing antibodies to IL-1beta, TNF-alpha and IL-6 were ineffective in suppressing any of these products. Together, these findings suggest that IL-18 may play an important, possibly direct, role in mediating cartilage injury, which might not be amenable to treatment with currently utilized anti-cytokine agents. These findings suggest further that IL-18 antagonists might prove beneficial as anti-inflammatory and chondroprotective agents in the treatment of arthritis, and that the development of such agents for human use is worth consideration.

Field study of a thermal environment and adaptive model in Shanghai

A long-term field investigation was carried out in naturally ventilated residential buildings in Shanghai from April 2003 to November 2004. A total of 1,768 returned questionnaires were collected in the study. This study deals with the thermal sensation of occupants in naturally ventilated buildings and the change in thermal neutral temperature with season. The range of accepted temperature in naturally ventilated buildings is between 14.7 degrees C T(op) and 29.8 degrees C T(op). The results also report the findings of the adaptive comfort model in Shanghai that determines the adaptive relationship of neutral temperature with outdoor air temperature. A long-term field study was carried out in residential buildings in Shanghai to find the relationship between thermal sensation, indoor neutral temperature and outdoor temperature. This paper presents findings of thermal comfort and discusses the more sustainable standard for the indoor climate of residential buildings in Shanghai.

The roles of interleukin-18 in collagen-induced arthritis in the BB rat

Interleukin (IL)-18 is a member of the IL-1 cytokine family. Its expression is increased in rheumatoid arthritis synovium, and its proinflammatory effects have been demonstrated in experimental models of murine arthritis. Here, we investigate the actions of varying doses of recombinant rat IL-18 (rIL-18) on the course of type II collagen-induced arthritis (CIA) in BB rats, including clinical and immune events, plus splenic cytokine production. Small doses of rIL-18 (10 and 50 microg/rat) administered intraperitoneally (i.p.) increased arthritis incidence and severity (P < 0.01) when a low-potency CII preparation was used for immunization. IgG1 and IgG2a anti-CII antibody levels were significantly greater in rats given 10 and 50 microg rIL-18 doses than controls. rIL-18 significantly increased levels of proinflammatory cytokines [interferon (IFN)-gamma, IL-2, tumour necrosis factor (TNF)-alpha and IL-6] produced by splenocyte cultures. Larger doses of rIL-18 (300 microg/rat) suppressed arthritis and immunity. To ascertain whether the pro-arthritic effects of IL-18 could be attenuated, rats were treated with neutralizing rabbit anti-rIL-18 IgG before immunization with a high-potency CII preparation. When given serially for 3 weeks, the incidence and severity of CIA, in addition to anti-CII IgG2a and splenic IL-6 and IFN-gamma production, were all significantly reduced. Similar results were noted when antibody was given twice, just before arthritis onset. These results demonstrate that IL-18 plays an important proinflammatory role in the pathogenesis of CIA which is achieved, in part, by an immunostimulatory action. Neutralizing endogenous IL-18 with antibodies attenuated CIA, CII immunity and cytokine responses. These studies support the use of IL-18 antagonists as treatments for inflammatory arthritis.

[Studies on the chemical constituents from Sophora flavescens ait]

OBJECTIVE

To study the constituents from Sophora flavescens.

METHODS

Separating the constituents by means of chromatography and identifying their structures on the basis of spectral analysis.

RESULTS

The five compounds obtained were identified as sucrose, lignoceric acid, beta-sitosterol, sinapic acid hexadecyl ester and umbelliferon.

CONCLUSION

Sinapic acid hexadecyl ester is a new compound. These compounds were obtained from the plant for the first time.

Characterization of recombinant type II collagen: arthritogenicity and tolerogenicity in DBA/1 mice

Recombinant human type II collagen (rhCII) was produced using both the HT1080 mammalian cell expression system (rhCIIht) and a baculovirus expression system (rhCIIbac). The biosynthesis of CII requires extensive post-translational modifications, such as the hydroxylation of prolyl and lysyl residues and glycosylation of hydroxylysyl residues. Amino acid analyses indicated that the rhCIIbac was adequately hydroxylated at prolyl residues but underhydroxylated at lysyl residues and underglycosylated compared with tissue-derived hCII, while rhCIIht was hyperhydroxylated and hyperglycosylated at lysyl residues. When the murine collagen-induced arthritis (CIA) model was used to investigate the immunological properties of the two forms of recombinant CII, each induced a high incidence of arthritis following immunization of susceptible mice when emulsified with complete Freund's adjuvant (CFA). However, the severity of the arthritis, as assessed by the number of affected limbs, was significantly higher in mice immunized with rhCIIht than in mice immunized with rhCIIbac. These data indicate that the degree of hydroxylysine glycosylation may play a role in the induction of the arthritogenic response to CII. Each of the recombinant collagens was comparable to tissue-derived hCII in their ability to induce tolerance and suppress arthritis when given as intravenous or oral tolerogens. Taken together, our data suggest that recombinant CII can be prepared in adequate amounts for therapeutic uses and that the material is immunologically comparable to tissue-derived hCII when used to induce tolerance.

Immunity to type IX collagen in rodents: a study of type IX collagen for autoimmune and arthritogenic activities

Type IX collagen (CIX), a cartilage-specific glycoprotein, constitutes < or = 10% of cartilage collagen. To ascertain whether CIX can induce arthritis as shown for type II and XI collagen (CII and CXI), outbred rats were sensitized with bovine, chick and human CIX; inbred rats, mice, and guinea pigs were sensitized with bovine CIX. Mice and guinea pigs proved resistant to arthritis, as did rats sensitized with CIX/Freund's incomplete adjuvant (FIA). Arthritis was seen in rats when 100 microg of Mycobacterium tuberculosis (Mtb) were added to FIA, but seldom with smaller doses of Mtb, suggesting the arthritis was adjuvant-induced. High levels of antibodies to rat CIX, containing complement-fixing subclasses, were detected in rat sera in addition to DTH and lymphocyte proliferation responses to rat CIX. Given the potential for CIX-induced disease, CIX-sensitized rats were injected intraperitoneally with lipopolysaccharide (LPS) to stimulate proinflammatory cytokine release, and intra-articularly with rat CIX to stimulate arthritis. LPS stimulation was ineffective; however, intra-articularly injected CIX produced transient synovitis. When rats with stable adjuvant arthritis were sensitized with CIX/FIA, significant increases in paw volume were measured compared with controls given CI/FIA. Immunohistochemical studies of actively and passively sensitized rats revealed deposits of CIX antibody, but not C3, at the joint margins where proteoglycan staining was weak. Together, these findings suggest that autoimmunity to CIX, in contrast to CII and CXI, is not directly pathogenic but may contribute to joint injury provided arthritis is initiated by an independent disease process.

Evidence for preferential T cell receptor V beta gene usage and T cell clonal expansion in the synovium of BB rats with early-onset collagen-induced arthritis

Type II collagen (CII) is a potent arthritogen in the BB rat. To determine whether a restricted group of T cells is involved in the pathogenesis of collagen-induced arthritis, lymphocytes from synovium, peripheral blood, and lymph nodes of arthritic rats were studied for T cell receptor (TCR) V beta gene usage using polymerase chain reaction (PCR). Oligoclonal TCR V beta usage was found only in synovium recovered day 2 post-arthritis onset, but not day 7; lymph node and peripheral blood T cells showed diverse TCR usage at both times. To determine whether T cell local clonal expansion occurred in synovium at day 2 of arthritis, cDNA for four TCR beta families was sequenced through VDJ regions. Strong selective expansion of TCR V beta 8.2, 4, and 17 was noted. Importantly, the dominant clonotype of V beta 8.2 was identical to that of a lymph node-derived T hybridoma specific for the immunodominant epitope in CII(181-210). Cells from synovium (day 2 postonset) analyzed by flow cytometry also showed V beta 8.2+ cell enrichment. These observations, plus finding that T cells from inflamed synovium respond to CII(181-201) in vitro, suggest the local recruitment and clonal expansion of some T cells families, possibly driven by autologous CII released during cartilage degradation.

Induction by chronic autoimmune arthritis in DBA/1 mice by oral administration of type II collagen and Escherichia coli lipopolysaccharide

We have developed a new model of autoimmune arthritis in DBA/1 mice by feeding chick type II collagen (CII) for 2-3 week intervals over a 15 week period. Clinically evident arthritis occurred in 8/10 mice receiving native CII (nCII; 100 micrograms/mouse) alone at 9-13 weeks. Arthritis was aggravated by the further ingestion of CII, while remission occurred after withdrawal of the CII. Heat-denatured CII (dCII; 200 micrograms/mouse) was also arthritogenic if co-administered with ovoinhibitor (OVI; 2 mg/mouse), a proteinase inhibitor. Co-oral administration of lipopolysaccharide (LPS; 10 micrograms/mouse) with CII enhanced the antibody production and T-cell responses to CII, and induced a more chronic arthritis that progressed spontaneously without further administration of CII or LPS. Long-term oral administration of LPS alone also induced a mild arthritis characterized by destruction of bone rather than cartilage. These observations suggest that abnormal gastrointestinal absorption of dietary mimic antigens and intestinal bacterial toxins can potentially disrupt self-tolerance mechanisms, thereby precipitating or exacerbating autoimmune disease in genetically susceptible individuals.

The mechanism of autoantibody formation to cartilage in rheumatoid arthritis: possible cross-reaction of antibodies to dietary collagens with autologous type II collagen

In order to study the mechanism of autoantibody formation to type II collagen in rheumatoid arthritis (RA), IgG and IgA antibodies in sera from 259 RA patients and 285 non-RA controls were evaluated for their specificity as to collagen type (I and II) and species (chick, bovine, and porcine) using an improved enzyme-linked immunosorbent assay. IgG and IgA anti-type II collagen antibodies were commonly found in both RA (IgG, 41%; and IgA, 45%) and non-RA (IgG, 36%; and IgA, 31%) sera. Both IgG and IgA collagen antibodies were highly reactive with one or more heterologous type II or type I collagen; however, approximately 35% of IgG and 50% of IgA antibody-positive sera from both RA patients and non-RA controls cross-reacted with human type II collagen (HII) to some degree. However, no antibodies specific to HII were observed in either RA or control sera. In individual patient sera, IgG and IgA antibodies had identical collagen-type and species specificities. Importantly, IgG anti-HII antibodies purified from RA sera by affinity chromatography reacted equally with human, chick and bovine type II collagens, suggesting reactivity with conserved epitopes shared by all three species. In contrast, purified IgG anti-HII antibodies from non-RA control sera commonly lacked reactivity with one or the other of the heterologous type II collagens, suggesting reactivity limited to epitopes shared by HII and only one of the heterologous type II collagens. These data suggest that dietary collagens could elicit circulating IgG and IgA anti-collagen antibodies that cross-react with autologous type II collagen. Also the epitope specificity of IgG autoantibodies may be relevant to the pathogenesis of RA.

Variable-region gene family usage for type II collagen autoantibodies in arthritis-susceptible DBA/1 mice

Collagen-induced arthritis is mediated by autoantibodies to type II collagen (CII). This experimental model has proven useful in determining the molecular and cellular mechanisms responsible for autoimmune arthritis. We have shown that polyarthritis can be transferred to normal mice by administering combinations of three or four complement-fixing monoclonal antibodies (mAbs) which recognize cross-reactive epitopes on the alpha 1(II)-CB11 region of chick and mouse CII. Currently, the light- and heavy-chain variable-region structures on a panel of alpha 1 (II)-CB11-specific mAbs that cross-react with chick and mouse CII, or react solely with chick CII, have been analyzed. The results indicate biased usage of VK19 and VK21 families of light-chain variable-region genes but random VH gene usage. Interestingly, two mAbs derived from different mice recognized identical epitopes on mouse CII and had nearly identical light- and heavy-chain variable-region structure including junctionally derived sequence.

Collagen-induced arthritis in mice: synergistic effect of E. coli lipopolysaccharide bypasses epitope specificity in the induction of arthritis with monoclonal antibodies to type II collagen

DBA/1 mice develop a chronic peripheral arthritis after immunization with type II collagen termed collagen-induced arthritis. We have localized the main arthritogenic determinants of CB11, a CNBr-generated arthritogenic fragment of chick type II collagen (CII), using 3 smaller peptide fragments of CB11 generated by endoproteinase LysC, LysC1 (CII 124-290), LysC2 (CII 291-374) and LysC3 (CII 375-402) and a panel of monoclonal antibodies (mAb) specific to CB11. MAb specific to the arthritogenic region of CB11 were also used to study the synergistic effect of E. coli lipopolysaccharide (LPS) on antibody-mediated arthritis in naive DBA/1 mice. LysC2 contained a minimum essential arthritogenic fragment of type II collagen: LysC2 induced arthritis by active immunization, also, a combination of four mAb specific to LysC2 passively transferred arthritis to naive mice. A single i.p. injection of LPS (50 micrograms/mouse) reduced the threshold values of the arthritogenic dose of mAb from 1 mg to 50 micrograms/clone per mouse, and decreased the number of mAb required for inducing arthritis from 4 to 2 clones. These observations suggest that LysC2, an 84 amino acid residue fragment, contains the main arthritogenic determinants within chick CB11. Importantly, LPS, a strong inducer of pro-inflammatory cytokines, negates the required multiple epitope specificity of autoantibodies in the passive transfer model and acts synergistically in the induction of arthritis by autoantibody.

Type XI collagen-induced arthritis in the Lewis rat. Characterization of cellular and humoral immune responses to native types XI, V, and II collagen and constituent alpha-chains

Autoimmune arthritis can be induced in rats by immunization with cartilage-specific types II and XI collagen. Type XI collagen is composed of alpha 1(XI), alpha 2(XI), and alpha 3(XI) chains, in which alpha 3(XI) is essentially identical to alpha 1(II) of type II, and alpha 1(XI) and alpha 2(XI) are similar to alpha 1(V) and alpha 2(V) of type V collagen. To characterize the immune response to type XI collagen, Lewis rats were injected with bovine type XI collagen, and the cellular and humoral responses were compared with those of rats injected with types V and II collagen. Arthritis, IgG deposits in cartilage, and joint destruction were seen in rats immunized with types XI and II collagen. Type XI elicited strong cellular responses to rat types XI, V, and II; conversely, types II and V collagen elicited strong responses to rat type XI. Antitype XI Abs reacted with rat type XI, moderately with rat type V, but poorly with rat type II. Direct and inhibition ELISA showed that cross-reactions between types XI and V collagen resulted from recognition of determinants shared by their respective alpha 2(XI) and alpha 1(V) chains. Abs eluted from joints of rats immunized with type XI collagen, however, reacted only with native rat type XI collagen. These data demonstrate that type XI collagen induces diverse populations of Abs differing in collagen-type specificity, and suggest that only those Abs to native rat type XI collagen are central to the pathogenesis of type XI collagen-induced arthritis.

Type XI collagen-induced arthritis in the Lewis rat. Characterization of cellular and humoral immune responses to native types XI, V, and II collagen and constituent alpha-chains

Autoimmune arthritis can be induced in rats by immunization with cartilage-specific types II and XI collagen. Type XI collagen is composed of alpha 1(XI), alpha 2(XI), and alpha 3(XI) chains, in which alpha 3(XI) is essentially identical to alpha 1(II) of type II, and alpha 1(XI) and alpha 2(XI) are similar to alpha 1(V) and alpha 2(V) of type V collagen. To characterize the immune response to type XI collagen, Lewis rats were injected with bovine type XI collagen, and the cellular and humoral responses were compared with those of rats injected with types V and II collagen. Arthritis, IgG deposits in cartilage, and joint destruction were seen in rats immunized with types XI and II collagen. Type XI elicited strong cellular responses to rat types XI, V, and II; conversely, types II and V collagen elicited strong responses to rat type XI. Antitype XI Abs reacted with rat type XI, moderately with rat type V, but poorly with rat type II. Direct and inhibition ELISA showed that cross-reactions between types XI and V collagen resulted from recognition of determinants shared by their respective alpha 2(XI) and alpha 1(V) chains. Abs eluted from joints of rats immunized with type XI collagen, however, reacted only with native rat type XI collagen. These data demonstrate that type XI collagen induces diverse populations of Abs differing in collagen-type specificity, and suggest that only those Abs to native rat type XI collagen are central to the pathogenesis of type XI collagen-induced arthritis.

Antibodies against a 30 kilodalton cochlear protein and type II and IX collagens in the serum of patients with inner ear diseases

Collagen molecules are major extracellular matrix proteins involved in the development and support of delicate auditory sensory organs. Type II collagen is widely distributed within inner ear tissues, while type IX is found only within the labyrinthine membrane and dense fibers of the tectorial membrane. Antibody specific for type II collagen has been shown to be elevated in some patients with hearing loss due to several presumably autoimmune illnesses (including Meniere's disease, otosclerosis, chronic progressive sensorineural hearing loss, and relapsing polychondritis). Purified human type II and IX collagens and an extract of human cochlear tissue were subjected to isolation by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and transferred to nitrocellulose. The sera of 21 patients with inner ear disease were examined for the presence of anticollagen and anticochlear antibodies; the sera were used to probe Western blots of purified human collagens II, IX, and XI, and cochlear protein extract with peroxidase-conjugated goat anti human polyvalent immunoglobulin as the second antibody. Anti-type II collagen antibodies were seen in 12 of 21 (57%) patients, while 13 of 21 (62%) had anti-type IX antibodies detectable by Western blot. A previously unreported 30 kd (probably noncollagen) protein was 21 (62%) had anti-type IX antibodies detectable by Western blot. A previously unreported 30 kd (probably noncollagen) protein was found by SDS-PAGE of human cochlear tissue extracts, with 3 patients, all with Meniere's disease, having antibody activity to this protein detected by Western blot.(ABSTRACT TRUNCATED AT 250 WORDS)

Monoclonal antibodies against bovine type IX collagen (LMW fragment): production, characterization, and use for immunohistochemical localization studies

Four high-affinity monoclonal antibodies (MAb) which react specifically with the low molecular weight (LMW) fragment of bovine type IX collagen (BIX) have been produced in mice. On the basis of the ability of these MAb to cross-react with type IX collagen purified from human, rat, and chick cartilage and to inhibit one another in a competitive inhibition assay, we conclude that the MAb D1-9, B3-1, and B2-7 recognize unique epitopes, whereas MAb B4-5 recognizes the same epitope as B3-1. None of the MAb reacted with bovine type I, II, and XI collagen. MAb D1-9 and B3-1 were tested for their ability to bind to tissue antigen, using an immunohistochemical assay system. Positive immunoperoxidase reactions were observed in the perichondrocytic regions of human and rat costochondral cartilage. Positive responses were also detected in rat auricular cartilage, as well as in tissue obtained from the middle and inner ears of rats and mice. This report demonstrates the relative ease of producing MAb to heterologous type IX collagen and the utility of these MAb for localizing type IX collagen in cartilage and cartilage-like tissues.